? 31/03 Need guidance for Maggie

[hellen_maggie]

26/03 Maggie AMPS 349/+3 220/+6 257/+9 297 PMPS 302/+2 154/+3 88/+3.30 73/+4 71/+4,30 92 REDUCTION EARNED

Hi everyone,

I wanted to share an update on Maggie and ask for your guidance, as the last few days have been quite challenging. During the night cycles, we’ve been seeing a lot of green numbers, which is encouraging. However, her morning readings are still very high. I think these are bounces following the lower numbers overnight.

At the same time, we have finally been able to make some progress with her food transition. We’ve been gradually reducing the dry food and increasing air-dried food, bringing her carbs down from about 24% to around 15%, and we’re continuing. The transition is very slow , we remove about 7g of dry food every 3 or 4 days, as this is the only pace she tolerates.

Regarding dosing, every time she drops below 90, I reduce the dose. However, instead of reducing by 0.25U, I’ve been experimenting with smaller reductions because in the past she didn’t respond well to full 0.25 reductions. This morning I did not reduce, even though she earned it, because she has only been on 0.40U for 2 days and I was hesitant to make back-to-back reductions, especially since her numbers are still overall quite high.

Honestly, the last few days have been exhausting. The night cycles are very active, I’m not getting enough sleep, and with a very demanding workload at the office, I feel mentally drained and not thinking clearly. I would truly appreciate any guidance or suggestions, as it feels like we’re on a constant roller coaster right now and I’m not sure how to move forward.


Thank you so much for your help

 

[Bandit's Mom]

Her numbers are looking so much better now, although I can imagine how exhausted you must be!

The higher numbers in the day are a result of bouncing from the greens at night.

It takes only 4 cycles (2 days) for the depot to adjust to reductions at the size of the dose that Maggie is at. I think you can try 0.25U. It's possible that she needs less insulin after the food change. Some cats also "flip a switch" once they start seeing better numbers and race down in dosing. You can always go back up in dose, if required. It's not unusual for a cat to earn reductions and then need an increase before going back down in dosing. It's all part of the FD roller-coaster!

You also need a break! You have to take care of yourself too!

If you aren't already, try giving her some of her PS meal at +1 and +2 and see if you can get flatter curves?

 

[hellen_maggie]

Her numbers are looking so much better now, although I can imagine how exhausted you must be!

The higher numbers in the day are a result of bouncing from the greens at night.

It takes only 4 cycles (2 days) for the depot to adjust to reductions at the size of the dose that Maggie is at. I think you can try 0.25U. It's possible that she needs less insulin after the food change. Some cats also "flip a switch" once they start seeing better numbers and race down in dosing. You can always go back up in dose, if required. It's not unusual for a cat to earn reductions and then need an increase before going back down in dosing. It's all part of the FD roller-coaster!

You also need a break! You have to take care of yourself too!

If you aren't already, try giving her some of her PS meal at +1 and +2 and see if you can get flatter curves?

Thank you so much for your guidance, Bhooma, I really appreciate it
Our current feeding schedule is as follows: a main meal at preshot (about 35% of her total food), and then small snacks at +0.5, +1.5, +2.5, and +4. There is no food available after +4. I’ve been doing this since her biggest drops usually happen between +2 and +3, and I’ve been trying (not very successfully!!) to smooth out the curve this way. Do you think this schedule could be improved?

Also, would it be too risky to hold the 0.40U dose a little longer? To be honest, I’m quite afraid that she might drops harder by remaining at the same dose, and I also really need some rest, as the night cycles have been very demanding. On the other hand, I worry that if I reduce to 0.25U, she might stay high throughout the day, and I don’t want to put her at risk from prolonged high numbers either.

I hope all of this makes sense, my thoughts are a bit all over the place from exhaustion.


Thank you again

 

[Allie & Gen]

I wish I had more insight to offer, but I think everything you're doing makes a lot of sense ... I'm so glad to hear that there's been progress on the food transition! And the incremental reductions are smart! And it sounds like she's on an ideal feeding schedule.

The frequent bouncing sounds really frustrating; bouncing in general is the aspect of FD that we seem to understand the least and it bothers me to no end, so really I mostly have sympathy to offer on that!

It might be a good time to try and hold your course for a bit to try and ease some of the constant stress on you. (I don't mean no reductions/increases, but sticking with your overall current approach.) You're already doing so much, and you are seeing some results. Maggie's AM numbers aren't ideal, but she's pretty stable and staying mostly below the renal threshold; "prolonged" high numbers is somewhat relative (I haven't seen any data around here about at what point long-term damage becomes a concern, it's something I need to look into more), but I don't think there's much chance of that happening on the kind of timescale you'd be looking at with a single reduction. Meanwhile, there's a good chance you'll continue to see improvement from the changes in her diet.

Time to put on your patience pants and hang in there? Believe me, I know it's hard. I'm trying to live with constant stress about Gen's horrible numbers right now (and admittedly that may be affecting my judgement, since Maggie's are so much better, relatively speaking). Hugs.

 

[Mary & Jude]

Hi Hellen, Jude has done this before, and let me offer my hugs to you for the late nights--they can be brutal. Actually Jude's been doing a lot of bouncing lately--just a step into lower numbers causes a bounce (though, granted, not as high as Maggie). It's worth a try to reduce the dose. As Bhooma says, you can always take her back up if the reduction fails. Plus, it will give you a chance to catch your breath.

 

[Bandit's Mom]

Sorry for the delay in responding!

Our current feeding schedule is as follows: a main meal at preshot (about 35% of her total food), and then small snacks at +0.5, +1.5, +2.5, and +4. There is no food available after +4. I’ve been doing this since her biggest drops usually happen between +2 and +3, and I’ve been trying (not very successfully!!) to smooth out the curve this way. Do you think this schedule could be improved?

This feeding schedule is fine. Maybe you could try +1, +2, +3, +4 and see if that makes a difference. It's all trial and error. And different cycles can play out differently on the same dose and same feeding schedule. The joys of feline diabetes!

Also, would it be too risky to hold the 0.40U dose a little longer? To be honest, I’m quite afraid that she might drops harder by remaining at the same dose, and I also really need some rest, as the night cycles have been very demanding. On the other hand, I worry that if I reduce to 0.25U, she might stay high throughout the day, and I don’t want to put her at risk from prolonged high numbers either.

It's doesn't seem risky right now to hold the dose since you monitor closely, and she isn't dropping below 65. But I wouldn't stand against a moving train if it looks like she wants to go lower in dosing. As you lower the % of higher carb food, she will need less insulin. You also need rest. You can always go back up if she needs more insulin. It's par for the course for their insulin requirement and consequently, the dose to go up and down.